Minimally invasive technologies are expected to reduce short and long-term side effects of standard surgical treatments for BPH (in particular TURP) while preserving effectiveness on functional outcomes. The aim of this report, which was carried out by the Italian HTA institution RER in collaboration with AIHTA, is the assessment of 21 minimally invasive technologies in comparison to TURP, open prostatectomy or with each other.

As for functional outcomes (IPSS, Qmax, PVR and QoL), statistically significant differences are shown in few comparisons and results are, most of the time, below the threshold for minimal clinically important difference. Quality of the related evidence has been graded low to very low, suggesting limited confidence in the estimates and that further research may be likely to change these estimates.

In terms of impact on sexual activity, moderate to low/very low quality evidence shows that ThuLEP, TUIP, Aquablation, and PUL may provide some advantage over TURP.
Regarding other possible safety outcomes and side effects, some newer technologies may offer some advantage over TURP, e.g. a reduced need for blood transfusions. The occurrence of urinary tract infections and incontinence has only been investigated for a small number of interventions, and the results were mixed, indicating both a reduced and an increased occurrence of these.